Employee’s Withholding Certificate

Employee’s Withholding Certificate
Department of the Treasury Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS.
Step 1:
(a) First name and middle initial*
Last name*
(b) Social security number*
Enter Personal Information
Address*
City or town, state, and ZIP code*
(c)*

Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of household Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.
Step 2: Multiple Jobs or Spouse Works
Mark this box if you have multiple jobs, including this one.

Yes
Step 3: Claim Dependent and Other Credits
COMPLETE THE FOLLOWING STEPS ONLY IF they apply to you and you have less than $200,000 in income (or $400,000 if you file taxes jointly.)
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500 .....
Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here.
Step 4 (optional): Other Adjustments
4(a) If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income ........
4(b) Extra withholding. Enter any additional tax you want withheld each pay period .
Step 5: Signing
By signing, under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it
Signature*

Clear
Today’s Date*

MonthDayYear
Date
Your Date of Birth*

MonthDayYear
Date
Should be Empty:

Employee’s Withholding Certificate

Step 1:

Enter Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependent and Other Credits

Step 4 (optional): Other Adjustments

Step 5: Signing